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The use of sodium MRI in the diagnosis of an anaplastic astrocytoma during immunotherapy: a case report

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Abstract

Gliomas in the pediatric population are targeted with immune-modulating therapies. The gold standard imaging modality for diagnosis and monitoring treatment response is magnetic resonance imaging (MRI); however, the complex post-therapy-induced changes can make treatment response assessment difficult. These include radiation necrosis, pseudoresponse, and pseudoprogression, as well as more complex responses in the setting of immunotherapy. We report a case of an 11-year-old male with a supratentorial astrocytoma (WHO grade 3) that underwent treatment with immunotherapy. There was a clinical concern for progression due to increased fluid-attenuated inversion recovery (FLAIR) hyperintensity at the site of the primary neoplasm during immunotherapy. However, the Sodium (23Na) MRI continued demonstrating decreased total sodium concentrations, supporting pseudoprogression over true progression, which was confirmed clinicaly. This case reports the capability of 23Na MRI to differentiate between progression, recurrence, and other posttreatment changes.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Pennsylvania, 19104, PA, USA

    Laura De Leon-Benedetti & Aashim Bhatia

  2. Department of Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Srikala Narayanan & Ashok Panigrahy

  3. Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Vincent Kyu Lee

  4. Radiological Sciences Laboratory and Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, Stanford, CA, USA

    Fernando Boada

Authors
  1. Laura De Leon-Benedetti
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  2. Srikala Narayanan
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  3. Vincent Kyu Lee
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  4. Ashok Panigrahy
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  5. Fernando Boada
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  6. Aashim Bhatia
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Contributions

L. D., S. N., V. L., and A. B wrote the main manuscript. All authors reviewed the manuscript.

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Correspondence to Aashim Bhatia.

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De Leon-Benedetti, L., Narayanan, S., Lee, V.K. et al. The use of sodium MRI in the diagnosis of an anaplastic astrocytoma during immunotherapy: a case report. Childs Nerv Syst 40, 965–967 (2024). https://doi.org/10.1007/s00381-023-06195-6

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  • DOI: https://doi.org/10.1007/s00381-023-06195-6

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